Introduction With increased access to information, women across the globe are becoming more actively involved in their care, especially during the Perinatal period. Occupational Therapists are holistic practitioners working with individuals through the lifespan, and Women's Health is an emerging frontier for OT practice. With increased OT practitioner and consumer interest in this stage of life, there needs to be more evidence to support OT's role in the medical care team during the perinatal period. Further discussion in this post is based on the open source article “Effect of pelvic floor muscle training on postpartum sexual function and quality of life: A systematic review and meta-analysis of clinical trials” by Talasz et al (2019).
The article can be found at : https://www.sciencedirect.com/science/article/pii/S1028455919302086?fbclid=IwAR15Y-JU9rR-KFaZHdCPmy78EfI0t0-aAGwqiziHGa_p8Ld2DBlmQ2sgbmE#bib24
The article reviewed in this post was not authored by Occupational Therapists, but reviews an intervention - Pelvic Floor Muscle training - that is frequently employed by OTs practicing in Women's Health. Specifically, the study of Sexual Health during the perinatal period is interesting as it is an aspect that is often ignored. As the woman’s body recovers physically and emotionally from birthing, it is easy to overlook the ADL of Sex amongst the larger changes in the woman’s life which usually include an identity shift to being a mother, loss of previous occupations (work role outside home, active social life, prior physical activities & leisure pursuits), new occupations (infant caregiving, breastfeeding, viewing partner in new role of parent) and changes in social support systems.
The article discussed helps to fill the gap in knowledge of postpartum sexual function by using a Systematic Review design to analyze the available research in English and Persian to determine the effect of Pelvic Floor Muscle (PFM) training on postpartum sexual function and quality of life. By demonstrating the positive effects of PFM training on postpartum recovery, it helps strengthen the role of Occupational Therapists in the postpartum care team. Below is a superior of the Pelvic Floor Musculature that is targeted in PFM training interventions. Performing internal PFM assessment & intervention is beyond the scope of practice of entry-level Occupational and Physical Therapy practitioners. Please refer a client in need of PFM training to a qualified professional.
Study Design
The researchers used a keyword search to find English & Persian studies in the following databases - PubMed, CINAHL, Medline, Scopus, Google scholar citations, SID and Iran Medex. The PICOT method was used to select studies as listed below: P (Population): women with pelvic organ prolapse, I (Intervention): pelvic floor exercise, C (Comparison group): watchful or other types of therapies, O (Outcome): Sexual function, T (Time or duration): Pregnancy or postpartum.
Only studies using a quasi-experimental and randomized controlled trial (RCT) design were used for meta-analysis. Studies that tested interventions on women birthing via cesarean section were excluded from analysis. The search resulted in 347 titles and abstracts, which were narrowed down to 12 potentially eligible articles. The 3 major outcomes measured were: - Sexual Function – 5 studies - Appropriate function in any stage of the sexual process- desire (or libido), excitement, lubrication, orgasm, satisfaction, and pain - Sexual quality of life – 2 studies - Satisfaction with sexual outcomes with self, single or multiple partner(s) - Quality of life – 3 studies - A broad ranging concept that includes a person's physical health, psychological well-being, social relationships, and sexual satisfaction Two articles were excluded from meta-analysis, because they were pre-post clinical trial and did not have control groups.
Findings & Generalizability
A statistically significant increase in sexual function was found, when pelvic floor muscle exercises were used during the postpartum period. The American Occupational Therapy Association recognizes that Sex and Sexuality are important occupations (https://www.aota.org/About-Occupational-Therapy/Professionals/RDP/Sexuality.aspx) addressed by OTs across practice settings. The use of physical exercises, such as PFM training as a component of care falls within Occupational Therapists’ scope of practice, and should be used with individuals in the perinatal period.
Limitations
One limitation of the study was the significant heterogeneity introduced by different intervention methods used in the studies analysed. The article also had grammatical errors which can be attributed to the authors not being native English speakers.
Practice Implications and Conclusion
Pelvic floor muscles play an important role in sexual function (other functions are support of abdominal organs, sphincteric control of bowel & bladder and stabilization of pelvis). Given that pregnancy and childbirth are factors in weakening the pelvic floor muscles, PFM training is an important intervention in improving sexual function, which will subsequently improve the quality of sexual life and overall QoL. Based on the study reviewed and other existing evidence, health professionals should encourage women to perform postnatal exercise with a qualified provider. Referral to an Occupational Therapist with advanced training in Women’s Health will enable women to have access to PFM training and psychosocial approaches to ease the transition to motherhood, which can help improve postpartum health outcomes. Medical care providers should also encourage adherence to and continuation of postpartum recovery programs at postpartum care appointments, rather than only providing informational support in the form of pamphlets & other reading material.
Women's Health is an emerging area of rehabilitation and Occupational Therapists should aim to actively participate in contributing to it clinically and academically. Sujata Martin, MS OTR/L is a Women's Health Occupational Therapist specializing in preventative and rehabilitative Pelvic Floor Therapy focusing on the Pregnant and Postpartum Woman. She is based in Buffalo, USA, and can be contacted at https://mothernurturewny.com/
@Sophie Glad to see new grads going for non traditional OT roles.
P.S- you could post on the community forum page regarding resources
good luck,
Charmi
I'm so glad this topic was chosen for review. I am a recent OT grad and just completed my Master's thesis on sexuality and older adults. Women's health is definitely on my radar as an area I might like to specialise in.
I'm unsurprised by the results of this study, the PFM training in the postpartum benefits sexual function. I'm wondering how this might change in countries other than Iran where sexual concerns is perhaps not discussed with health -professionals. I would also be interested to see results from a pre-post test design.
However, I'm wondering if anyone has resources on specific interventions an OT can implement in this field, perhaps links to further training, or places to start learning about Women's health and OT as I am more familiar with these interventions from a physiotherapist. Cheers!